Recurrent Gastric Cancer after Absolute Curative Resection

Habu, Hiroshi; Sunagawa, Masakatu; Takeshita, Kazuyoshi; Endo, Masatoshi

doi:10.1159/000171762

Cited by 6 publications

(17 citation statements)

References 4 publications

(5 reference statements)

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“…Liver or other distant metastases are extremely unusual for early gastric carcinomas. The postoperative recurrence rate was significantly less in patients without nodal involvement than in those with nodal involvement [15,16], and the 10-year survival rate was significantly worse in the latter patients (52-67%) than in the former patients (nearly 94%) [3,8], demonstrating that the presence or absence of lymph node metastases is likely to influence the probability of postoperative recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…(2) The tumor should be elevated macroscopically. (3) The tumor should be histologically well differentiated. (4) The tumor should measure 10 mm or less.…”

Section: Discussionmentioning

confidence: 99%

“…Some early gastric cancers involve none of the regional lymph nodes [3,4,13] and require neither gastrectomy nor nodal dissection. Conservative treatment of early cancer is not as disabling as extensive treatment and is favored by patients; however, some tumors may recur locally even when patients seem to have undergone a histologically complete resection of the lesion [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, the treatment of early gastric cancer has recently changed, and some carcinomas are now treated by limited surgery, such as laser irradiation, endoscopic mucosal resection, or laparoscopic wedge resection of the lesion [1,2] because many mucosal carcinomas are free of nodal involvement. Approximately 1.7% to 7.0% of mucosal carcinomas have positive nodes, whereas 7.4% to 20.9% of submucosal carcinomas have positive nodes [3][4][5][6][7].…”

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confidence: 99%

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Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

et al. 1998

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Some early gastric carcinomas are free of lymph node involvement; however, the pathosis of these carcinomas is neither well understood nor reflected in the choice of less extensive treatment. We investigated the relation of nodal involvement to pathologic findings of the resected specimens. We present promising standards for predicting the nodal status of early gastric carcinomas, contributing to the indication for limited surgery. The relation of lymph node metastasis to tumor size, infiltration depth, macroscopic appearance, and histologic type of early gastric carcinomas were investigated in 1470 patients with a single primary early gastric carcinoma. Of these carcinomas, 763 were limited to the mucosa (mucosal carcinoma) and 707 to the submucosa (submucosal carcinoma). The overall incidence of lymph node metastasis was 9.0%: 2.1% in mucosal carcinomas and 16.5% in submucosal ones, with a significant (p < 0.001) difference of nodal involvement between the two. The macroscopically elevated or compound-type carcinomas 10 mm or less in diameter were all node-negative, whereas some depressed-type carcinomas were node-positive. The incidence of undifferentiated carcinomas increased with tumor diameter, irrespective of whether they were mucosal or submucosal carcinomas, and they were significantly more node-positive than were differentiated carcinomas: p < 0.001 for mucosal carcinomas and p < 0.05 for submucosal ones. The carcinomas satisfying the following criteria are node-negative and eligible for limited surgery: (1) mucosal carcinoma; (2) elevated lesion < 10 mm in diameter; (3) differentiated adenocarcinoma; and (4) no ulcer or ulcer scar. The other carcinomas are potentially node-positive and standard surgery is recommended.

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Section: Discussionmentioning

confidence: 99%

“…(2) The tumor should be elevated macroscopically. (3) The tumor should be histologically well differentiated. (4) The tumor should measure 10 mm or less.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

et al. 1998

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“…67 Including all two-fold interactions between the prognostic factors into the model leads to different types of results. In fact, carcinomas of the gastric cardia have the worst prognosis of all ~i t e~~~~~~,~~,~~,~~ probably due to a high propensity for esophageal extension and metastasis to lymph n~d e~.~~,~ The majority are of advanced stage and their anatomic location makes surgical treatment difficult, hence the tumor may not be completely resected.…”

Section: Stagingmentioning

confidence: 99%

Has there been any improvement in the staging of gastric cancer?. Findings from the German gastric cancer TNM study group

Rohde

Gebbensleben

Bauer

et al. 1989

Cancer

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This multicenter observational study examined the survival of 1420 patients with histologically proven carcinoma of the stomach. From April 1982 through October 1984, 1360 (95%) patients underwent surgery, 988 (72%) had resections, and 372 (28%) minor surgical procedures. The percentage of patients who have been followed until death or 3 to 5 years was 99.4%. Patients were staged preoperatively and intraoperatively and by pathologists using the old (1978) and new (1987) TNM stage groupings and 5-year survival was analyzed. Subgroups of patients who changed their stage group according to the new stage definitions were analyzed separately. Only age was an important prognostic factor for survival in Stage IA (P less than 0.05) and Stage IB (P less than 0.01). Residual tumor after surgery was most important for survival in Stage II (P less than 0.01) and Stage IIIA (P less than 0.001). This indicates that improvements of stage definitions for individual prognosis can only be achieved by adding data concerning the presence or absence of residual tumor (R classification).

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Prognostic factors for gastric cancer influencing clinical practice

Harrison

Fielding

1995

World j. surg.

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Despite a slow decline in the incidence of gastric cancer over the last 90 years, we can still expect to see over 100,000 patients die of this disease each decade in England and Wales. The 5-year survival rate has not improved during this century, which is largely due to the stage at diagnosis being unchanged. There are a number of prognostic determinants in gastric cancer which have clinical relevance. Age is an important determinant; patients under 40 years commonly have more advanced diffuse lesions than older patients so that a higher index of suspicion needs to be maintained in younger patients with persistent symptoms. Conflicting reports make it unclear whether the duration of symptoms bears any relationship to tumor stage, but there is some evidence that actively shortening the symptom duration by early investigation can have a beneficial effect in the proportion of patients diagnosed with early cancers. The site of the tumor is important; unfortunately, the proportion of patients with cardia lesions is increasing and this has had the effect of reducing the overall survival. Tumor size should not play a part in the decision to resect a lesion as most studies show no clear relationship between tumor size and stage. Tumor stage is the most important prognostic determinant and efforts to increase the proportion of stage I cancers presenting for surgery can be shown to alter the natural history of the disease, by diagnosing it when it is still surgically curable.

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Recurrent Gastric Cancer after Absolute Curative Resection

Cited by 6 publications

References 4 publications

Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

Assessing the Suitability of Gastric Carcinoma for Limited Resection: Endoscopic Prediction of Lymph Node Metastases

Has there been any improvement in the staging of gastric cancer?. Findings from the German gastric cancer TNM study group

Prognostic factors for gastric cancer influencing clinical practice

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